Do We Store Packed Red Blood Cells under “Quasi-Diabetic” Conditions?

Abstract

Red blood cell (RBC) transfusion is one of the most common therapeutic procedures in modern medicine. Although frequently lifesaving, it often has deleterious side effects. RBC quality is one of the critical factors for transfusion efficacy and safety. The role of various factors in the cells' ability to maintain their functionality during storage is widely discussed in professional literature. Thus, the extra- and intracellular factors inducing an accelerated RBC aging need to be identified and therapeutically modified. Despite the extensively studied in vivo effect of chronic hyperglycemia on RBC hemodynamic and metabolic properties, as well as on their lifespan, only limited attention has been directed at the high sugar concentration in RBCs storage media, a possible cause of damage to red blood cells. This mini-review aims to compare the biophysical and biochemical changes observed in the red blood cells during cold storage and in patients with non-insulin-dependent diabetes mellitus (NIDDM). Given the well-described corresponding RBC alterations in NIDDM and during cold storage, we may regard the stored (especially long-stored) RBCs as "quasi-diabetic". Keeping in mind that these RBC modifications may be crucial for the initial steps of microvascular pathogenesis, suitable preventive care for the transfused patients should be considered. We hope that our hypothesis will stimulate targeted experimental research to establish a relationship between a high sugar concentration in a storage medium and a deterioration in cells' functional properties during storage.

Variability of extracellular vesicle release during storage of red blood cell concentrates is associated with differential membrane alterations, including loss of cholesterol-enriched domains

“…As a consequence, exaggerated phosphorylation events could occur and alter the cytoskeleton occupancy. The transient increase of ATP agrees with Gevi et al (Gevi et al, 2012) but is in discordance with other studies that described a slight but constant linear decrease (Burger et al, 2010;Karger et al, 2012;Livshits et al, 2021). During their ex vivo storage, RBCs are immersed in a highly concentrated glucose solution.…”

Erythrocyte Deformability and Na,K-ATPase Activity in Various Pathophysiological Situations and Their Protection by Selected Nutritional Antioxidants in Humans

“…It is also important to consider that the deformability of freshly collected erythrocytes is variable already on the day of donation and the aging curve of erythrocyte deformability varied significantly among donors [ 74 ]. An additional source of storage-induced complications resulting in damage of erythrocytes may be the high concentration of glucose in storage mediums ranging 40–111 mmol/L; for review, see [ 75 ]. The functionality of the Na,K-ATPase also decreased in erythrocytes with the storage time of prophylactically irradiated blood samples.…”

Evaluation of selected hematological, biochemical and oxidative stress parameters in stored canine CPDA-1 whole blood

“…According to some studies, the concentration of glycated Hb in donated blood increases over time. It is not known whether this has a significant impact on metabolism and cytoskeleton remodeling [27]. Overall, acidification of the cell environment may alter membrane transport and metabolism, leading to faster erythrocyte deterioration [28].…”